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  4. Time is spine: What's over the horizon

Time is spine: What's over the horizon

Journal of Clinical Orthopaedics and Trauma, 2022 · DOI: https://doi.org/10.1016/j.jcot.2022.102043 · Published: October 22, 2022

Spinal Cord InjurySurgeryTrauma

Simple Explanation

The primary goal in treating acute spinal cord injury (SCI) early is to minimize secondary damage, which can help improve neurological and functional recovery. Surgical intervention is considered a valuable treatment for SCI, but the best timing and surgical techniques are still debated. Current guidelines support the idea that 'Time is Spine,' emphasizing the importance of reducing the time between trauma and surgery.

Study Duration
Not specified
Participants
Adult patients with spinal cord injury
Evidence Level
Narrative Review

Key Findings

  • 1
    Early surgical decompression (within 24 hours) is associated with improved neurological outcomes in SCI patients.
  • 2
    Studies suggest the greatest prospect of recovery if surgery is performed within the 24-36 hour period after injury.
  • 3
    Ultra-early surgery (within 8-12 hours) may lead to better outcomes, especially in patients with incomplete SCI or central cord syndrome.

Research Summary

The review emphasizes the importance of early surgical decompression in acute spinal cord injury (SCI) to reduce secondary damage and improve neurological outcomes. While evidence supports early intervention, the optimal timing for surgery remains a subject of debate, with studies exploring different time cut-offs (e.g., <24 hours, <12 hours, <8 hours). Barriers to early surgery exist, including delays in transfer to SCI centers and operating room availability, highlighting the need for improved healthcare delivery systems.

Practical Implications

Clinical Practice

Reinforces the importance of timely surgical intervention for SCI patients, advocating for protocols that minimize delays.

Healthcare Policy

Highlights the need to address administrative and logistical barriers to ensure more patients receive early surgical treatment.

Future Research

Encourages further high-quality studies, including randomized controlled trials, to determine the optimal timing and techniques for surgical decompression.

Study Limitations

  • 1
    Heterogenous time limits for early surgery across studies
  • 2
    Small number of patients in many studies
  • 3
    Observational, single-center study designs

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